Abstract

Background

Anaemia of chronic kidney disease increases the risk of death and adverse events,
but can be managed using erythropoiesis stimulating agents (ESAs). However, recent
evidence suggests that targeting a higher haemoglobin concentration ([Hb]) increases
mortality risk, and both higher [Hb] targets and ESA doses have been implicated. Nonetheless,
a causative role has not been demonstrated, and this potential relationship requires
further appraisal in such a complex patient group.

Methods

The relationship between the haematopoietic response to ESAs and patient survival
in 302 stable, prevalent dialysis patients was explored in a prospective, single-centre
study. Clinical and laboratory parameters influencing mortality and ESA resistance
were analysed. Patients were stratified into 5 groups, according to their [Hb] and
ESA dosage, and were followed for 2 years.

Conclusion

ESA dose does not appear to contribute substantially to mortality risk in dialysis
patients. Instead, age and co-morbidities appear to be the critical determinants.
A poor response to ESAs is a marker of overall poor health status.